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Home My WebLink AboutBuilding Permit #578 - 13 ANNIS STREET 5/1/2018 BUILDING PERMIT Ot 110RTH t�eo 06 q.{ 0. `- ib Opp TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION # Permit NO: Date Received ' �qS q�7ED�p �y SACHU`-+E Date Issued: �2/ IMPORTANT: Applicant must complete all items on this page LOCATION AAADS ` Print PROPERTY OWNER r/s .zz .` Print MAP NO: PARCEL: y ZONING DISTRICT: Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family ddition' Two or more family Industrial A ffera ion No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Wel Floodplain Wetlands Watershed District Water/Sewer _DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: tlaime: �lil/,S 91;. tI' Phone: 9'7�l F.�/• 17 7 Address: CONTRACTOR Name:- Phone: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Re . FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMA 1 R Total Project Cost: $, J, 5-0 id FEE: $ , i Check No.: 7 6 op-. Receipt No.: 21 gfl NOTE: Persons contracting wit unr g t e retractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor Location No. Date NORTH TOWN .OF NORTH ANDOVER 3�Oi�•�•� !��yoo ' Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # / 6e 2 ; 9 1 Building Inspector Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools Well Tobacco Sales Food Packaging/Sales Private(septic tank,etc. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS XCONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT -Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) 1, J ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (if Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 F N0RTH TOANM of : t 4Andover No. 4,.T78 y zdover, Mass., T O - LAKE COCKICKEWICK V 7��oRATED PPS` Co �l BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT 2 ...........0............. .. ... �............................................................................................................ Foundation has permission to erect....................... ................ buildings on .�,.. . . .....!!,t/llc.J.....f............................................. Rough to be occupied as.. .!W:j-t. .......�1.. /a. .6.......................S.�.Gf!�e!^ Chimney ........................... ....... Ch provided that the person accepting this permit shall in every respdci conform to the terms of the application on file in ; al this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS eough LECTRICAL INSPECTOR UNLESS CONSTRUCTIO STAR .............................. Service ........... ...................................................... ......... BUIL ING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. PLOT .PLAN LOCATED DEED BK. 990 PG. 73 OWNER: �h'�sroPyerz,,�'C'acL EEn/ ,E'er z� PLAN NO: SCALE: BK. zss PG. 6 d DATE: INV. NO. 6365 ,9ssFsso e s .eE,�EeE.�cE': /�AP 9, L aT 9. i /sTo,ey W.F, M � 2�2 S-ro,eY 1 \ 8, NOTE: Propsr)y lines shown hereon are from record information, no instrument survey was performed. This plan is not to be modified for any other use without consent of Northstar Land Survey Services. I OF NSS4 %J# O R T H S TA R JEFFREY A LAND SURVEY SERVICES HOFMANN #36381 THE TANNERY"—SUITE 7 AR FEB P.O. BOX 13 NE+YVBURYPORT, MA O 1950 ° TEL :(978). 465-29146 . FAx :(.9 78). 465- 11017 EMAIL :NORTHSrARO 19SOdPAOL.COM pORTM TOWN OF NORTH ANDOVER OFFICE OF p BUILDING DEPARTMENT +` 1600 Osgood Street Building 20, Suite 2-36 North Andover Massachusetts 01845 1S3AC►IUS�� Gerald A Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Please pdpt DATE: 42 9 d 9 JOB LOCATION: /3jI/,v� Number Street Address Mapfw - HOMEOWNER a 2 zE Name Home Phone Work Phone PRESENT MAILING ADDRESS C 5;1if City Town State Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings to two units or less and to allow such homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor). State Building (Code Section 108.3.5.1) DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there' r is,0 1s Intended to be a one or two A structures. who constructs more family person that one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliances with the State Building Code and other Applicable codes,by-laws,roles and regulations. The undersigned"homeowner"certifies that he/she�und-rstands the Town of North Andover Building Department minimum inspection procedures and regniM?"and that he/ will comply with said procedures and requirements. /j HOMEOWNERS SIGNATURE fl i APPROVAL OF BUILDING OFFICIAL Revnd 10.2005 Foam Homeowms Exa WOon I RO.1RD OF \PPEA1.S 6g8-95d.r CONSERVATION C88-9530 ITE-U, ll(M-9540 PLANNING 688--9535 o s The Commonwealth of Massachusetts Department o ' P f Industriall4ccidents r 1�, O lee o•� :; ft f.investigations 600 Washington Street Boston , MA 0111 W WMl.krzass.govIdia Workers' Compensation Insurance.AfficFavit: guilders/Contractors/Electricians/Plumbers An licant Information Please Print Leaibiv Name (Business/Organization/individual): S Address: 43 t -- City/State/Zip: ,/ ? Phone#:_ 97 ov Are you an employer?Check the appropriate box: 1.❑ I am a employer with 4. ❑ 1 am7a--eneralTYPe of Project(required):contra;for and Iemployees(full andlor part-tune).* haved the sub-contractors6 ❑ New construction2.❑ 1 am a sole proprietor or partner- listethe attached sheet ?• ❑ Remodeling ship and have no employees These sub contractors have working for me in any capacity. workers' comp. insurance. g' ❑ Demolition 'A [No workers' comp. insurance 5. ❑ We are a corporation and its 9' ❑ Building ad.diti.on z required officers have exercised.their 10.❑-Electrical repairs or additions P�l am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions yseIf. [No workers' comp. c. 152, §1(4),and we have no insurance required.] t employees. [Noworkers,rk. rs 12.❑ Roof repairsairs comp. insurance required.] 1.3•7 Other *Any applicant.that checks box#1.must also-fill out the section below showing their workers'compensation policy information. +Homeowners"0 subntil•tltis aiidevit indieatiltg tiie-% af•8 uunir e6i Wyk Lhc 2contractors Thal check this box must attached an additional sheet showing the nAme of ott u aontraciurs muni submit a now am`davir indicating such, h--'b-c0 Motors and their workers'comp.pol icy information. t am an.employer that is providing workers'compensation insurance for m3'employees, Below is the Policy and job site information. Insurance Company Name: Policy#or Self-.ins. Lic.#: Expiration Date: Job Site Address: Attach a copy oCity/State/Zip: f the workers' compensation policy declaration page(showin;the policy number and expiration date). .Failure to secure coverage as required under Section 25A of MGL c. 152 can iead to the imposition of criminal penalties of a fine up to S1,500.00 y at, one-year imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 a day at, the violator. Be advised that a co Investigations of the DI for insurance coverage verification. Py of this statement may be forwarded to the Office of I do e cert u er•the ns and ee o er u fP l rJ that the information provided above is true and correct S Si-mature: �1 y Date: G Ph6�2 . Official use onlp. Do not write in this area, to be completed by city or town ofgiciaL Cite or Town: PermitfLicertse Issuing Authority(circle one): i 1. Board of Health 2. Building Department 3. City/Tow•n Clerk 4 Electrical inspector 5. Plumbing Inspector 6. Other Contact Per-son: Phone I Information awd Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined.as"..every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association, corporation or other legal .entity,or any two or more of the foregoing engaged in a joint enterprise,and includi-n-the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 162, §25C(6)also states that"every state o r local licensing agency shall withhold the issuance or renewal of a license or permit,to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence o.f compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority.". Applicants Please fill out the workers' compensation affidavit compll-et-ely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)name(s),address(es) and phone numbers)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have _ employees, a policy is required_ Be advised that this aftidLavit maybe submitted to the Departnent of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have.any questions resL-dinv the lain or if you are required to obtain a workers' compensation policy,please call the Department at the nix- nber.listed below,,- Sel;insured comranies should enter their self-insurance license number on the appropriate line. City or Town Officiais Please be sure that the-affidavit is complete and printed leQib}y. The Department has provided a space at the bottom of the affidavit foryou to fill out in the event the Office of'Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in arty given year,need only submit one affidavit indicating current policy information(if necessary) and under".lob Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a Iicens� or permit not related to any business or commercial ventlu e (i.e. a dog license or permit to burnleaves etc.) said person is NOT required to complete this affidavit. f The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 6:00 WaslL ngton Street Boston; SLA 02111 Tel. # 617-727-4900 ext 406 c r 1-977-MASS.4-FE Revised 5-26=05 Fax#617-72.7-7749 WW°.Mass.bovldia